Pediatric Digitalis Toxicity Follow-up

  • Author: Kenneth T Kwon, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Jul 9, 2010
 

Further Inpatient Care

  • Consider the hospital admission of any patient with a history of a large ingested dose, especially if coexisting risk factors increase his or her susceptibility to digoxin toxicity.
  • Admit a patient to intensive care unit if he or she has signs or symptoms of toxicity.
  • Any patient receiving Fab fragments requires observation in an intensive care setting for at least 24 hours.
  • Patients who have had an unintentional exposure but no signs or symptoms of toxicity after 12 hours can be discharged from the hospital.
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Deterrence/Prevention

  • Individualizing the dosing of cardiac glycosides appears to be the key to their optimal use. The desired plasma concentration endpoint is 2 ng/mL in patients younger than 2 years and 1.5 ng/mL in patients older than 2 years.
  • Medical, nursing, and pharmacy staff should carefully monitor the prescription, dispensing, and administration of digitalis. These personnel can help to prevent errors in dosing by paying careful attention to decimal points.
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Complications

  • Arrhythmias can cause inadequate tissue perfusion with resultant CNS and renal complications such as the following:
    • Hypoxic seizures
    • Encephalopathies
    • Loss of vasoregulation
    • Acute tubular necrosis
  • Hyperkalemia is the major electrolytic complication in acute massive digitoxin poisoning. In pediatric patients, hyperkalemia can be a complication of acute toxicity.
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Patient Education

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Contributor Information and Disclosures
Author

Kenneth T Kwon, MD  Director of Pediatric Emergency Medicine, Associate Clinical Professor, Department of Emergency Medicine, University of California at Irvine Medical Center, Co-Director, Pediatric Emergency Services, Mission Regional Medical Center/Children's Hospital of Orange County at Mission

Kenneth T Kwon, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Megan Boysen, MD  Resident Physician, Department of Emergency Medicine, University of California Irvine Medical Center

Megan Boysen, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William T Zempsky, MD  Associate Director, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

William T Zempsky, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

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